Hold Congress Accountable

About FreedomConnector

Find activists, groups, and events right in your own neighborhood. Join FreedomConnector to get involved and learn more about key issues threatening our economic freedom. Whether you’re looking for like-minded people, trying to boost your existing group’s impact, or simply trying to stay up on current events, FreedomConnector is the place to start. See what’s happening in your state today!

Search FreedomWorks

Resources

Blog

Obamacare: Fundamentally Bad Design, Website Included

The technical problems with the implementation of the (Abdominable) Affordable Care Act are becoming the stuff of legend. The entire thing should be rebuilt. But that will not save the ACA, because the underlying policies and political pressures that have caused the problems are even worse than the systems so far created to deliver it.

There are two areas of abject failure in the ACA system implementation: the "front end" and the "back end." Sharp readers will note there is nothing else left to fail.

The front end is the web site and systems used to communicate with the user. The back end consists of dozens of interlocking computer and communications systems among government agencies and their crony industry partners, reaching even into the examination room. Both the front and back ends are disasters, and both disasters are driven by the structure of the ACA itself.

The Front End

The front end has drawn much of the attention so far, and is not ready even though Health and Human Services officials said it would be:

Initially, users were forced to create accounts before doing any shopping. HHS released a tool to let people see the prices in their area, but to see subsidy qualification they still have to create an account.

The account creation process is filled with problems all of its own.

This is Not How It's Done. Users of amazon.com or travelocity.com do not have to do that. Those sites know that account creation drives away users while slowing down the system, especially the part of the system used to register new users.

Industry observers say, and the compressed timelines attest, that nobody tested it. Because of the political need to open October 1 (resulting from the partisan nature of the law's origin), testing was not done.

Experts said the decision to require that consumers create online accounts before they can browse available health plans appears to have led to many of the program’s technical problems. Consumers trying to create their accounts multiplied the volume of online transactions that have overwhelmed the website.

The White House suggested they simply needed to improved the consumer experience. The incredible departure from best practices of the omission of testing can't be overstated.

The Back End

Health insurance expert Bob Laszewski says that only 5,000 people have signed up for insurance through the federal exchange. While the numbers are bad, the behind-the-scenes picture may be worse:

For some reason the system is enrolling, unenrolling, enrolling again, and so forth the same person. This has been going on for a few days for many of the enrollments being sent to the health plans. It has got on to the point that the health plans worry some of these very few enrollments really don't exist.

The reconciliation system, that reconciles enrollment between the feds and the health plans, is not working and hasn't even been tested yet.

The bureaucracy is ill-equipped to solve these systemic problems, particularly when the bureaucracy itself may be part of the problem. HHS is treating these fundamental problems as help desk issues (emphasis added):

Federal health officials declined to discuss the problem with the enrollment reports. “As individual problems are raised by insurers, we work aggressively to address them,” said Brian Cook, a spokesman for the Centers for Medicare and Medicaid Services, the branch of HHS that is overseeing the insurance exchange.

That kind of approach is unlikely to solve the problem. Perhaps they really are trying to get to the root of each problem they encounter, but passively waiting for insurers to report problems in a system that is massively failing will lead to duplication of effort and a great deal of waste. Individual symptoms may or may not be seen as part of the same underlying problem.

It would be easy to pass off the technical failures as "glitches" or to blame the contractors and federal employees who have created the systems. There are clearly issues with data exchange, system design, plain errors in the coding, and a lack of testing.

We envision a streamlined, secure, and interactive customer experience that will maximize automation and real-time adjudication while protecting privacy and personally identifiable information. Individuals will answer a defined and limited set of questions to begin the process, supported by navigation tools and windows that open to provide or seek additional information based on individual preferences or answers. The application will allow an individual to accept or decline screening for financial assistance, and tailor the rest of the eligibility and enrollment process accordingly. The required verifications that will be necessary to validate the accuracy of information supplied by applicants will be managed in a standardized fashion, supported by a common, federally managed data services hub that will supply information regarding citizenship, immigration status, and federal tax information.

In the backend of Obamacare, this complex set of systems for insurers, the IRS, Health and Human Services, and other federal and state agencies connect via a "hub," responsible for collecting information about an applicant and indicating what kind of insurance the poor sap should get. As late as June of this year, the code for the hub had not yet been written.

“They’re doing testing this week because they haven’t got the bugs out. They still aren’t sending clean files,” said Laszewski. “The insurance industry is scared to death.”

Driven By Bad Policy

All of the technical problems can be traced back to the toxic political origins of the law, however.

Were it not for the partisan way in which the original bill was crafted, and the even more partisan means by which the thing was passed,

There would have been input from Republicans as to what would be acceptable to their voters and in their state legislatures

The bill could have gone to conference, instead of being passed in its unworkable condition, so many of the errors could have been taken out

Republican states would not have been so sure to avoid implementing their own exchanges

There may not have been quite so many Republican governors and state legislatures in the first place

The structure of the law led to an overemphasis of creating user accounts

As mentioned above, the political need to open October 1 (because delay of the law was so politically difficult) has led to a lack of testing, and doubtless contributed to the overall poor quality of the entire system

The ACA ought to be repealed, and this stupid episode in disrupting the American Experience put behind us. Failing that, the entire thing should be put on hold for a year. Even simply dropping or delaying the individual mandate would take enormous pressure off of everyone and give time for a true public beta test.

Republicans, as those wisely opposing this debacle, must stand firm if the public is to be protected from the calamity of the Abominable Care Act.

Another interview has surfaced in which Jonathan Gruber, the MIT economist whose bragged about being involved in writing ObamaCare, suggested that subsidies will not be available to consumers in states that don't set up health insurance exchanges under the so-called "Affordable Care Act."

Since the passage of ObamaCare in 2010, critics of the law have endured the criticism that we’re all about opposition, without providing constructive alternatives for health care reform. The truth is closer to the polar opposite – if anything, we suffer from a surplus, rather than a deficit, of comprehensive plans to repeal and replace ObamaCare.

Americans already spend some 6 billion hours and $168 billion each year complying with a complex and onerous tax code. But ObamaCare is going to make tax filing even more of a chore for consumers who received subsidies for health plans purchased through the state and federal exchanges.

Cornell University has announced a $350 fee for students who don't enroll in the Ivy League school's Student Health Insurance Plan (SHIP), and students are pushing back against the administration, going as far as storming into the office of the school's president, David Skorton.

As the second ObamaCare open enrollment period came to a close over the weekend, more Americans learned that they owe Uncle Sam money because they received subsidies that were too great, in many cases because they had underestimated their income levels for 2014 when they applied for coverage through the health insurance exchanges.

With solid control of both the House and the Senate, one of the clearest mandates delivered to the Republicans in Congress was to repeal the onerous takeover of health care known as ObamaCare. This year, the new Congress has the greatest opportunity yet to fulfill that mandate – by using the budget process known as reconciliation. As millions of Americans are forced to pay a fine for not buying health insurance, and with millions more still struggling with high premiums and deductibles, there is no reason why Republicans should not use a tactic that can place a full repeal of the so-called “Affordable Care Act” upon the president’s desk.

The Supreme Court will hear arguments for the King v. Burwell case starting March 4th, with a decision likely to come down sometime in June. The Court’s decision will determine whether the IRS’ illegal implementation of ObamaCare subsidies to states that refused to set up insurance exchanges can continue. If not, the true cost of ObamaCare will be revealed to the American public, a cost that has until now been partially concealed by the IRS’ decision to circumvent the written law.

While the federal government often entices states to promote its agenda by promising “free” federal money for the states that adopt their programs, this money is never free, and always comes with strings attached. When the federal government offers “free” money for a program it is really just hoping to get the states hooked on the program before the giveaways disappear, much like a drug dealer who offers you the first hit for free.